This is an application for a Mental Health Services Research Scientist Development Award, Level II. The award will permit the applicant to continue his development as a health services researcher. The application proposes to undertake three projects involving patients with somatization disorder, schizophrenics who are continuously hospitalized, and schizophrenics who have substance abuse problems. These three clinical conditions are all chronic, severely disabling, and very costly. The approach to these problems is to test straightforward clinical interventions with careful attention to carefully defined samples, health status outcomes and economic outcomes. The first project, currently underway, is a randomized controlled cost- effectiveness study of a psychiatric intervention with 85 patients with somatization disorder and 75 patients who somatize but who are just below diagnostic criteria for the disorder. The application proposes to extent this work addressing questions of validity and utilization with a family study of all first degree relatives using structure psychiatric assessment for Axis I and Axis II disorders, a dimensional personality assessment, and a quantification of their health care utilization. A further test of validity is a 5 year follow up study of 191 carefully define somatization disorder and somatizing patients. The second project tests a social-learning intervention in schizophrenics who have been continuously hospitalized for over 4 years and who are refractory to outpatient management. This study will also be a cost-effectiveness study and seeks to enhance the patients' movement into alternative treatment. The third project tests the cost-effectiveness of an social skills/family intervention,in schizophrenic patients with ' co-morbid substance abuse. The application describes a professional growth plan which will improve the candidate's research capabilities. Further, the applicant has assembled successful consultants and collaborators which will aid his research development.